Provider Demographics
NPI:1245200765
Name:MOSES GRANT, FLORENCE J (MD)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:J
Last Name:MOSES GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FLORENCE
Other - Middle Name:J
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:1800 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2369
Practice Address - Country:US
Practice Address - Phone:570-703-8259
Practice Address - Fax:570-703-7250
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173085207L00000X
PAMD034389E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
81F541Medicare ID - Type Unspecified
E95162Medicare UPIN